Evaluation of the Usefulness of Computed Tomography on Diagnosis and Management of Acute Abdomen

Takehiro Sakai, Nobuo Yagihashi, Tadaharu Osawa, Osamu Harada and Hiroyuki Ito*

Department of Surgery, Kuroishi City Hospital
Ito Geka-Naika Clinic*

Purpose: We evaluated the usefulness of computed tomography (CT) in diagnosing and managing acute abdomen. Patients and methods: Subjects were 91 patients admitted complaining of acute abdominal pain and divided into two groups-those undergoing CT within 24 hours of admission (emergency CT group, n=70), those without CT (Non-CT group, n=21). The emergency CT group was subdivided into those with bowel obstruction (bowel obstruction group, n=29), those with acute appendicitis and other diseases necessitating differential diagnosis (appendicitis group, n=36), those with perforation of the digestive tract (perforation group, n=4), and other disease (n=1). We evaluated the accuracy of admission diagnosis retrospectively in each group. Results: The final diagnosis of the bowel obstruction group was adhesive bowel obstruction in 16, colon cancer in 5, external hernia in 3 and other in 5. That in the appendicitis group was acute appendicitis in 25, colonic diverticulitis in 3, pelvic inflammatory disease in 3, ovarian hemorrhage in 2 and other in 5. The origin of perforation in the perforation group was upper digestive tract in 2 and lower digestive tract in 2. The sensitivity, specificity and accuracy of admission diagnosis in the emergency CT group was 91.1, 100 and 91.4%, respectively. The accuracy of admission diagnosis was 96.5% in the bowel obstruction group, 88.9% in the appendicitis group and 75.9% in the perforation group. Patients who could not be diagnosed precisely consisted of 6 patients in the emergency CT group. Those who could not be diagnosed precisely included 3 with pericecal abscess, 1 with acute appendicitis, 1 with stercoral perforation of the sigmoid colon and 1 with impacted bezoar in the small intestine. Evaluated retrospectively, 4 patients were able to be diagnosed by CT on admission. Conclusion: In diagnosis of acute abdomen, CT was useful in differential diagnosis of bowel obstruction and acute appendicitis, detection of fine free air, and determine of perforated sites. Emergency CT was thus useful in detecting proper therapy for acute abdomen.

Key words
acute abdomen, computed tomography, bowel obstruction, appendicitis, perforation

Reprint requests
Takehiro Sakai Department of Surgery, Hirosaki City Hospital
3-8-1 O-machi, Hirosaki, 036-8004 JAPAN

Accepted
September 27, 2006

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